Is miscarriage care insensitive?
Imagine being in hospital with the knowledge you've just miscarried and lost your baby. But at the same time you're being kept on a ward where you can hear women going through labour and life entering the world.
It happened during Julie Orford's first miscarriage and was just one instance of what she describes as "insensitive care" during a "really, really frightening" time.
"I found it quite distressing that I was in the process of losing my baby, when I could hear others actually having their baby downstairs," she told the BBC.
Julie, 40, from Suffolk, miscarried - as happens in one in five pregnancies in the UK - in 2008, when 11 weeks pregnant.
After she was told her baby had no heartbeat, she said she felt like she was left on a hospital "conveyor belt" and her treatment was "very insensitive".
One of the issues was language. She said she felt like she was losing a baby, but doctors would only refer to "pregnancy tissue".
"It's very common for a miscarriage to happen - you very much just become part of the process.
"Perhaps you're not treated sensitively and spoken to in a way that would help you through that difficult time.
"I felt it was more like a medical procedure, there was never any talk of a baby or losing babies."New rules
Experiences like Julie's are why the National Institute of Health and Clinical Excellence (NICE) has published new guidelines for England and Wales, on dealing with women who miscarry or have an ectopic pregnancy (when a fertilised egg implants outside the womb).
- Miscarriages are common
- The first 13 weeks of a pregnancy is the most common time for a miscarriage
- Half of all early miscarriages are caused by a chance abnormality that's unlikely to happen again
- Poor nourishment by the placenta or an abnormality in the baby's development can lead to a later miscarriage
- About one in 100 women will have recurrent miscarriages
The NICE panel highlighted huge differences in pregnancy services across the country, with some available seven days a week, while others operated only for three mornings.
One of the recommendations was to set up dedicated early pregnancy assessment services. These would include a 24-hour contact number for women who have problems during their pregnancy.
Prof Mark Baker, director of the centre for clinical practice at NICE, said: "It's vital that women and their families receive good, consistent, timely and effective care and support that addresses their needs and enables them to make informed decisions.
"We know that not every woman is receiving this level of treatment at the moment, but this guideline will address that inconsistence and ensure all women receive excellent care, no matter where they live."
He added: "It's not rocket science to separate people who are losing a baby from people who are having a baby."
Mary Ann Lumsden, a professor of gynaecology and medical education at Glasgow University who led the panel, said it was about creating "a pivotal central point in the care of these women.
"It's an excellent opportunity for all the care to be in one place."
She also stressed that it was important that women were treated sensitively: "It doesn't cost a great deal to be sympathetic.
"For each woman it is a unique event and we must recognise people's distress.
"Most healthcare professionals do a pretty good job and try to be compassionate, but there are examples of bad practice."
Jacqui Clinton, of the baby charity Tommy's, said women who lost a child due to an ectopic pregnancy often struggled to cope without seeking help.
"No matter how early on your experience, the loss of a baby can feel like a bereavement. We therefore welcome these guidelines, and any initiatives, to provide the best possible care and support for women and their babies."
Jane Munro, of the Royal College of Midwives, said the guidelines should help ensure standardised and consistent care for women.
"The focus on emotional support and information giving is important, so that women can be clear about their choices and make informed decisions," she said.